Fineman: What the Debate Should Be About

After covering the health-care debate for a year, I suppose I needed to clear my head and get some perspective on the medical world. But the way I accidentally did so was a little extreme, dramatic, and painful.

On a trip to visit our daughter in Argentina, I got a severe case of food poisoning, and spent two nights and three days in a small, private hospital in the breathtakingly beautiful (not that I cared!) Andes resort town of Bariloche.

Before I say more, here's the bottom line: I got great care at a tiny fraction of what the cost would have been in the U.S.—even correcting for cost-of-living and currency values.

My hospitalization included continuous intravenous fluids (to counter dehydration); IV antibiotics; an EKG, two blood tests and a chest X-ray; special meals; a private room; and even satellite-TV access to what seemed to be every obscure soccer match on the planet. The doctors, nurses, aides, and others were all uniformly excellent.

Total cost: about $1,500.

In the U.S., according to my survey of D.C. doctors (my own and others'), the equivalent care would have cost $10,000 to $15,000. That's probably not counting satellite TV.

The stark arithmetic, in turn, reminds me of what the debate here should be about but often isn't: how to control our immense and metastasizing medical-industrial complex, which is waging the equivalent of a costly Cold War against an Evil Empire of bad food, bad habits, and greed.

President Obama proclaims his plan (whatever it finally is) to be "reform." But from what I can see, it would merely feed, at taxpayer expense, 30 million currently "uncovered" people into a wasteful system that doesn't have either the price-signaling power of a marketplace or the sweeping overview and control of a state-run bureacracy.

Either alternative might work; the latter surely does, at least in a highly centralized, communitarian country such as France. But what we have, and will have even if the president has his way, is a simmering mess of neither-here-nor-there.

Most Americans have no idea how much their health care really costs, nor do they know how well it really works, compared with, say other places, practices or countries.

And there is no truly national administration of a sector of the economy that accounts for about $2.5 trillion in annual economic activity—an amount of cash roughly equivalent to the entire economies of the U.K. and Russia combined.

Now, Argentina is no role model. Their system is as much of a mash-up as ours. They spent a lot of money, proportionally (about 11 percent of GDP compared with 17 percent for us). We're 34th in the world in life expectancy; they are 45th, according to the CIA World Fact Book.

Most Argentines rely on a rickety public system; about a quarter get coverage through their place of work— which, in the leftist Peronist tradition, means through their union. Others—mostly the better off—rely on private, for-profit hospitals of all sizes and shapes.

I ended up in one of the latter, the Sanatorio San Carlos de Bariloche. I had passed out from dehydration on the way to the airport, but when my wife and daughter took me to the hospital I was aware enough to be a little worried about the place I was now entrusting with my life.

There was a gravel and dirt parking lot. The entrance to the emergency room looked like the side entrance to a warehouse. The waiting room had a few chairs in a tight row. I had no choice but to intimately examine the purple foot of an injured hiker sitting in the seat next to me.

The equipment was not fancy and not state of the art. On the other hand, my illness was not fancy, and I am not state of the art. What they had was more than enough for me.

The key is that the doctors were clearly well trained and knowledgeable, and inspired confidence with their touch of Argentine cockiness. American doctors have high regard for the education of most of their Argentine colleagues.

(They only problem: they spoke almost no English. Luckily our daughter speaks like a native Argentine and she served as translator for my wife and me.)

There was no waste in their rounds or in their supply rooms, it seemed to me. They treated me appropriately but not with flourish.

An example. To take a shower, I needed to have my IV connection covered to protect it against water. The orderly improvised a solution. He took a clean rubber glove and cut it off at the fingers and palm to make a protective sleeve.

That might not be a "best practice" in the U.S., but it worked.

In Argentina, perhaps they can't always afford the latest in technology, but they also strike me as doctors who don't dwell on technology for its own sake, or for the sake of impressing patients.

So, I had a minor (though painful and scary) ailment; and they took pretty much the line of least resistance in treating it. I was out of the hospital as promptly as possible, and on my way back to Buenos Aires with my family.

In figuring the bill, let's say that, since the Argentine peso is worth about one forth of a U.S. dollar, the "real" cost of my care in Bariloche was $6,000. That is still about half of what I would have paid back the United States.

Without getting into profound issues of lifestyle and culture (we are killing ourselves with fast food and lack of exercise) the main question we need to ask in the on-going health-care debate is this: where does all that extra money go?

Now that is a seminar the president should convene—before it's too late.

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